Project Summary Family-based Behavioral Treatment (FBT) is an evidence-based pediatric weight management intervention (PWMI) that targets both child and parent. More than 30 years of research indicate that FBT reduces children?s percent overweight by almost 20%, with the average parent losing about 20 pounds during treatment. FBT also meets the US Preventive Services Task Force Recommendations as a comprehensive treatment for childhood obesity delivering more than 26 contact hours. The proposed project brings together a multi-sector team of collaborators, with expertise in behavioral science, community-based implementation science, pediatrics, technology, health services, and health economics. This multi-sector team will package and pilot test FBT for the treatment of pediatric obesity in two sites, representing both rural and urban settings, towards the goal of increasing access to this evidence-based, effective treatment among low-income families with children ages 5 to 12. First, training and treatment will be packaged for dissemination in a turn-key, technology- enhanced format (Aim 1). Given the lack of certified health care providers who can deliver FBT--which creates a major treatment barrier for low-income populations--we will develop the first online FBT training platform that includes FBT training materials for interventionists and treatment support materials for families. To inform this digital treatment package, we will incorporate feedback from a broad range of stakeholders, including representatives from local community-based organizations that serve low-income families, health care providers, local provider organizations, and members of the target populations. Once packaged, the intervention will be implemented in two distinct primary care settings (rural and urban; Aim 2). Primary care offers an optimal setting for FBT delivery, as it capitalizes on the established relationship between primary care providers and families. Co-locating interventionists within the primary care setting overcomes fragmentation of care and addresses provider time and referral barriers. Further, this delivery strategy dovetails with Missouri HealthNet Division?s recent state plan amendment which is scheduled to take effect in Missouri in 2019 to cover intensive obesity behavioral counseling and medical nutrition therapy for Medicaid patients, thus setting the stage for scaling FBT implementation across primary care. Implementation outcomes of the packaged intervention will be assessed at the organizational-level (Aim 2A) and patient-level (Aim 2B). Additionally, a scheduled Medicaid reimbursement mechanism will be evaluated as a promising method for sustainability and can serve as a model for other reimbursement mechanisms for private and public payers across the nation. Finally, the packaged treatment will be optimized based on data and feedback from the study, and community partners will be engaged to develop a sustainability and dissemination plan (Aim 3). Establishing that FBT can be implemented in real world settings is crucial to creating a system where children and their families affected by obesity can be effectively treated in centralized primary care settings.